A quadricuspid aortic valve is an uncommon valve lesion. Its physical manifestations vary, and it may be associated with other cardiac lesions. Echocardiography is the imaging modality of choice, with computerized tomography or cardiac magnetic resonance imaging being utilized as adjunctive imaging modalities in certain cases. Herein, we present a case series of three patients with this valvular lesion treated at our institution, as well as a contemporary review of the literature.
Background: Right heart geometry and function is routinely assessed at the time of valve surgery utilizing intra-operative 2-dimensional transesophageal echocardiography (TEE). However, the correlation between TEE-derived and established transthoracic (TTE) measurements of right heart size and function is unknown. We aimed to compare quantitative echocardiographic parameters of tricuspid annular (TA), tricuspid valve, and right ventricular (RV) size and function as assessed by TTE and intra-operative TEE. Methods: Fifty-four patients who had combined mitral and tricuspid valve surgery were included. Right heart measurements were performed in the TTE apical 4-chamber (A4C) and RV inflow views, and TEE mid-esophageal 4-chamber (ME4C) and transgastric RV inflow views at end-diastole. Spearman correlation coefficients (r) were applied to test for associations between the imaging modalities.Results: The mean age was 65 years and 39% were male. All patients had ≥ moderate tricuspid regurgitation (TR), and a secondary/functional etiology was present in 89%. The median TAd and RV basal (RVd) diameters in the TTE-A4C view measured 37 mm [interquartile range (IQR), 34-44] and 43 mm (IQR, 40-51), respectively. The TTE-A4C TAd strongly correlated with the TEE-ME4C measurement (r=0.72), with an overestimation of 1 mm (IQR, −2 to 4) by TEE (P<0.01). For RVd, the TTE-A4C measurement correlated moderately with the TEE-ME4C view (r=0.61), underestimating the RVd by −1 mm (IQR, −4 to 3.3) (P<0.01). No correlation was observed between TAPSE measured by TTE and TEE (r=0.22, P=0.13).Conclusions: Intra-operative TEE may reliably quantitate TA and RV size and geometry. The current findings are best interpreted as hypothesis-generating for future validative studies.
Introduction:
Approximately 30% of patients with Takotsubo syndrome have biventricular involvement (BiV-TTS), which confers an increased morbidity. This study aimed to detail cardiac geometry, function and mechanics in BiV-TTS.
Methods:
Twenty-five patients diagnosed with BiV-TTS according to the InterTAK diagnostic criteria between 2006 to 2020 were retrospectively identified and analyzed with 2-dimensional and speckle-tracking strain echocardiography. An independent t-test, Mann-Whitney U-test, or Kruskal-Wallis test were used for the statistical analyses.
Results:
Mean age was 71.1 ± 17.9 years, and 56% were female. The LV ejection fraction was decreased (31.4 ± 12.2%), chamber size was increased (end-systolic volume index: 41.3 ± 10.2 ml/m2), and 48% had concentric remodeling. The right ventricular (RV) size was upper normal (40.6 ± 4.1 mm), and tricuspid annular plane systolic excursion was decreased (12.0 ± 2.6 mm). Sixteen patients had suitable images for speckle-tracking analysis. Global LV longitudinal strain was impaired (-7%, IQR -9.6 to -4.5), with significant differences between basal (-7.1%), mid (-4.3%), and apical (-0.2%) territories (P=0.001). Segmental strain within the LV base statistically varied, with the anteroseptum most impaired (-3.1%) and the inferolateral segments most preserved (-11%) (p=0.01). RV free wall strain was impaired (-9.9% ± 4.7), and differed between basal (-14.6%), mid (-11.9%), and apical (-5.4%) territories (P<0.001). Females had worse global LV (-4.6 vs. -9.5%, p=0.02) and similar RV free wall strain (-9.6 vs. -10.2%, p=0.78) impairment compared with males.
Conclusions:
Chamber remodeling, dysfunction, and mechanical impairment characterize BiV-TTS. Important differences exist in territorial and segmental strain values, and between genders.
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